Provider Demographics
NPI:1144504523
Name:SHAPIRO, JERALD EDWARD (LCSW #5905)
Entity type:Individual
Prefix:MR
First Name:JERALD
Middle Name:EDWARD
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:LCSW #5905
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1881 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2629
Mailing Address - Country:US
Mailing Address - Phone:925-944-1176
Mailing Address - Fax:
Practice Address - Street 1:1881 MEADOW LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-2629
Practice Address - Country:US
Practice Address - Phone:925-944-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL.C.S.W. 59051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical